Sedentary behaviour is increasingly recognised as a distinct physiological risk factor in ageing; however, its relationship with intrinsic tendon properties and postural balance remains undefined. The objective of this study was to determine whether Sedentary Behaviour is independently associated with gastrocnemius medialis tendon properties and postural balance in older adults, after accounting for physical activity. Healthy older adults (n = 105) completed this cross-sectional investigation. Habitual physical behaviour was quantified over 7 days using triaxial accelerometry. All participants subsequently underwent assessments of gastrocnemius medialis tendon mechanical, material, and morphological properties, with postural balance assessed in a representative subgroup (n = 45). Associations were examined using single and multiple linear regression, compositional data analysis, and isotemporal substitution models. Covariates were identified via univariate General Linear Model and entered using backward elimination prior to inclusion of behavioural predictors. Sedentary behaviour levels did not significantly predict gastrocnemius medialis tendon properties or balance outcomes in unadjusted models. Following covariate adjustment, Sedentary behaviour emerged as a significant negative predictor of eyes-open balance trial duration, representing the only independent SB-related effect across 18 outcome variables. Compositional analyses revealed significant model fits for multiple outcomes; however, these associations were substantially attenuated after covariate adjustment, suggesting no significant influence of Sedentary behaviour on gastrocnemius medialis tendon characteristics. Isotemporal substitution indicated small relative outcome changes (-0.71% to + 0.56%) following 10-minute behavioural reallocations. Although Sedentary behaviour pattern parameters were associated with select tendon and balance variables, most significant models were driven predominantly by covariates rather than Sedentary behaviour metrics. This study provides novel evidence that Sedentary behaviour is not independently associated with gastrocnemius medialis tendon structure and mechanics in older adults, yet is associated with poorer postural balance performance. These findings suggest that the association between Sedentary behaviour and postural balance is unlikely to be mediated by tendon degradation and instead implicate neural and motor control pathways as plausible mechanisms. Reducing sedentary time through increased physical activity may help mitigate balance deterioration and preserve functional independence with ageing.

BACKGROUND:The physical activity (PA)-independent associations between sedentary behaviour (SB) and muscle characteristics such as activation capacity, specific force, and fatigability remain underexplored. METHODS:105 older adults (72.8 ± 6.0 years), wore a 3D-accelerometer for 5-7 continuous days, to quantify free-living SB and PA, followed by assessments of the gastrocnemius medialis (GM) muscle using isokinetic dynamometry, electromyography (EMG), ultrasonography and percutaneous electrical stimulation. Associations with SB were examined using multiple analytical approaches, before and after adjustment for covariates. RESULTS:Multiple linear regressions (MLRs i.e. for total daily accumulations, and patterns) - SB accumulation explained much of the variance in optimal angle for maximal voluntary force, even after adjustment for all covariates (R2adj = 0.318, P < 0.01). Interestingly, Fifteen MLR models identified associations between SB patterns and GM functional and structural outcomes (R2 4.2% to 41%, P < 0.05), with five models remaining significant following adjustment. Compositional Analyses - Ten compositional models predicted GM function and/or structure (R2 11.5% to 39.8%, P < 0.05), with one (that predicting EMG amplitude during isometric fatigue) remaining significant following adjustment. Isotemporal substitutions - Reallocating 10-mins between physical behaviours was associated with GM outcomes e.g. muscle strength, specific force, activation capacity and fatigability (P < 0.05). DISCUSSION & CONCLUSION:In older adults, how sedentary time is accumulated is a key correlate of muscle function. Targeting prolonged SB, ideally through introducing Light-Intensity PA, rather than focusing solely on increasing MVPA, may provide a practical route to preserving muscle health.

Sedentary behaviour (SB) and physical activity (PA) have been shown to be independent modulators of healthy ageing. We thus investigated the impact of activity monitor placement on the accuracy of detecting SB and PA in older adults, as well as a novel random forest algorithm trained on data from older persons. Four monitor types (ActiGraph wGT3X-BT, ActivPAL3c VT, GENEActiv Original, and DynaPort MM+) were simultaneously worn on five anatomical sites during ten different activities by a sample of twenty older adults (70.0 (12.0) years; 10 women). The results indicated that collecting metabolic equivalent (MET) data for 60 s provided the most representative results, minimising variability. In addition, thigh-worn monitors, including ActivPAL, Random Forest, and Sedentary Sphere—Thigh, exhibited superior performance in classifying SB, with balanced accuracies ≥ 94.2%. Other monitors, such as ActiGraph, DynaPort MM+, and GENEActiv Sedentary Sphere—Wrist, demonstrated lower performance. ActivPAL and GENEActiv Random Forest outperformed other monitors in participant-specific balanced accuracies for SB classification. Only thigh-worn monitors achieved acceptable overall balanced accuracies (≥80.0%) for SB, standing, and medium-to-vigorous PA classifications. In conclusion, it is advisable to position accelerometers on the thigh, collect MET data for ≥60 s, and ideally utilise population-specific trained algorithms.

OBJECTIVE:In women, the age-related decline in skeletal muscle structure and function is accelerated after menopause, which implicates the role of decreased circulating estrogen levels. Indeed, boosting estrogen, by means of postmenopausal hormone therapy (HT), generally proves beneficial to skeletal muscle. The evidence regarding whether these benefits persist even after cessation of HT is limited, nor is it clear how physical behavior (PB) impacts on benefits. Hence, this exploratory study focused on the interplay between HT administration/cessation, PB and in vivo skeletal muscle structure and function.METHODS:Fifty healthy women (≥60 y) were included; 19 had an HT administration history (≥9 mo, with now ~8-y hiatus in treatment) and 31 no such history. On seven continuous days, PB data were collected using triaxial accelerometry and analyzed using compositional data analysis. Gastrocnemius medialis muscle volume, architecture, and function were determined using ultrasonography, electromyography, dual x-ray absorptiometry, and dynamometry. Current serum estradiol levels were measured using ELISA.RESULTS:Only fascicle length and duration of HT administration were positively associated. With respect to PB levels, we found a pattern suggesting greater vitality (higher physical activity and lower sedentarism) in previous HT users, compared with nonusers, despite the two groups currently no longer exhibiting significantly different levels of circulating estradiol.CONCLUSIONS:After an 8-year hiatus in treatment, HT provides limited advantages in gastrocnemius medialis muscle properties. Interestingly, it perhaps enhances vitality despite prolonged cessation, which in the longer term would facilitate greater physical independence, especially considering the association of sedentary behavior with greater frailty.

Prolonged sedentary behaviour (SB) i.e. longer bouts, is suggested to have a range of negative health effects, independent of habitual light and medium-to-vigorous physical activity (LIPA or MVPA). Any effect on musculoskeletal size, architecture or morphology has seldom been reported in older adults. Moreover, no study has yet determined if any association would persist following adjustment for covariates. Therefore, the aim of the present study was to investigate the associations between SB, and properties of the Gastrocnemius Medialis (GM) muscle, in a cross-sectional sample of older adults using compositional data analysis. 105 healthy older adults (73±6y) wore a thigh mounted tri-axial accelerometer for seven consecutive days, and underwent ultrasound [e.g. muscle length (Lm), anatomical cross-sectional area (ACSA), muscle volume (VM), fascicle length (LF), & physiological cross-sectional area (PCSA)], body composition (e.g. DEXA) and health (e.g. medical history) assessments. In-unadjusted models, SB time was negatively associated with ACSA at 75% of Lm (R2adj = 0.085), VM (R2adj = 0.020), and PCSA (R2adj = 0.039). Standing was positively associated with pennation angle (R2adj = 0.110), which persisted following co-variate adjustment (R2adj = 0.296). In fully adjusted models, both SB & LIPA time were associated with ACSA at 75% of Lm (Both R2adj = 0.393). Standing and light activity time were also associated with LF, VM, & PCSA (R2adj 0.116-0.573). In fully adjusted models, SB pattern parameters (i.e. the manner in which sedentary behaviour is accumulated daily throughout waking hours such as the timing, duration and frequency of sedentary bouts), were associated with GM muscle properties (R2adj 0.156-0.564) including LM, LF, and VM. The pattern, rather than accumulated daily SB time, was associated with the size and architecture of the GM. Our results suggest that regardless of co-existing habitual physical activities, SB bouts should be kept short and frequently interrupted to offset some of the deleterious ageing-related muscle architecture characteristics changes.

Tools for objective monitoring of home-based training and physical behavior (PB) in (pre)sarcopenic older adults are needed. The present study explored two approaches with machine learning models, including accelerometer data either with or without additional gyroscope data (in an inertial measurement unit). Twenty-five community-dwelling (pre)sarcopenic adults mean 80.7 [5.5] years) performed the Otago exercise protocol (OEP) and PB modules (e.g., sitting or walking) while wearing an inertial measurement unit on the lower back (Dynaport MoveMonitor; McRoberts, The Hague, The Netherlands). Machine learning (ML) models for classification were developed by two approaches (top-down and bottom-up approaches) and with two levels of classification: general (no wear, OEP, and PB) and detailed (all subclassifications). Classification output was compared with video recordings. For the bottom-up approach, one ML model was developed. For the top-down approach, data were first classified as no wear, OEP, or PB. Thereafter, OEP and PB were subclassified by one ML model each into subclassification. Only classification of the general classification no wear and the subclassification sitting/lying reached the acceptable performance threshold of 80%. This result was independent of the approach used. Moreover, a gyroscope did not improve performance. Despite the progress in ML techniques and monitors, objective compliance registrations remain challenging.

Performance on activities of daily life (ADLs) is often used to evaluate older adults' capability of living independently. Current sensor technology has already accomplished classifying several types of ADLs automatically. However, thus far, limited studies were performed in bathroom activity monitoring. In this study, we proposed using one wearable accelerometer to monitor six types of bathroom activities: dressing, undressing, washing hands, washing face, brushing teeth and toilet using. One hidden-layer neural network model was applied for activity classification. The acceleration signal was separated into patterns, using 16s sliding window with 50% overlapping. The model was developed both with (a) 10-fold cross validation or (b) leave-one-person-out (LOPO) of the training set. The classification result was evaluated on precision, recall and F1-score. The F1-score was varied in these bathroom activities. In 10-fold cross validation, the highest average F1-score was of 91.19%, which was for toileting, and the lowest average F1-score was of 51.91%, which was for washing face. In LOPO, toileting still had the highest F1-score of 80.00%, but washing hands had the lowest F1-score of 9.62%. Additionally, we tested whether one participant's toileting event can be monitored in 3 consecutive days in the LOPO mode. The F1-score for classifying toileting events was 85.61%. In sum, the results show that it is possible to use one wearable accelerometer to monitor toileting activity. However, for the other bathroom activities, further study is needed and personal differences in these activities' performance should be considered.

Background It has been advocated that older adults should concomitantly spend less time in sedentary behaviour (SB), and engage in sufficient physical activity (PA), to reduce their risk of cardio-metabolic diseases. However, it is not clear what intensity of PA must be done to offset SB engagement. Aim Model how cardio-metabolic profiles could change if older adults replaced an hour per day (hr·day-1) of a physical behaviour intensity with 1 hr·day-1 of another physical behaviour of a different intensity. Methods Older adults (n = 93, 60–89 years old, 55% female) wore a thigh-mounted triaxial accelerometer for seven consecutive free-living days to estimate mean daily hourly engagement in SB, Standing, Light Intensity PA (LIPA), sporadic moderate to vigorous physical activity (sMVPA, bouts <10 continuous minutes), and 10-minute MVPA (10MVPA, bouts ≥10 continuous minutes. Fasting whole blood concentration of plasma glucose, triglyceride, total cholesterol, and glycated haemoglobin (%), along with serum concentration of lipoprotein lipase (LPL), interleukin-6 (IL-6), and procollagen III N-terminal propeptide (PIIINP) were measured. Results Isotemporal Substitution, with covariate adjustment, suggested that: total cholesterol concentration could theoretically decrease when 1 hr·day-1 of SB is replaced with Standing, when 1 hr.day-1 of LIPA is replaced with Standing, and when 1 hr·day-1 of sMVPA is replaced with Standing. Triglyceride concentration theoretically decreased when 1 hr·day-1 of SB, Standing, LIPA, or sMVPA is replaced with 10MVPA. Triglyceride concentration theoretically increases when 1 hr·day-1 of 10MVPA is replaced with SB, Standing, or LIPA. No associations with time reallocation appears to exist for LPL, HbA1c, IL-6, and PIIINP. Conclusion The type of physical behaviour being replaced could be crucial for total cholesterol maintenance. Engagement in 10MVPA could be necessary to improve triglyceride concentration.

Following publication of the original article [1], the authors reported an error on the content of Availability of data and materials section in their paper.

Sedentary behavior (SB) has emerged as an independent public-health risk and may contribute to the lower bone mineral density (BMD) in old (>60 years of age) than young adults. The purpose of this study was to quantify SB and habitual physical behavior (PB) in community-dwelling older adults and how this correlates with BMD. In 112 relatively healthy and independent-living individuals aged 72.5 ± 6.4 years, BMD, PB and SB were determined using dual energy X-ray absorptiometry and 7-day three-dimensional accelerometry, respectively. In men, only healthy and osteopenic BMDs were found, whereas in women, osteoporotic BMD classifications also occurred. Our sample spent ∼61%, 7%, 12% and 19% of daily waking hours in SB, standing, LIPA [light intensity physical activity (PA)] and MVPA (medium-to-vigorous intensity PA), respectively. In men, after accounting for covariates (BMI, total fat, android:gynoid ratio), sleeping (hours/day), number of breaks in SB, number of SB ≥ 5 min, number of PA bouts, total duration of PA bouts (min), mean PA bouts duration (min), LIPA (%PA bout time) and MVPA (%PA bout time) were all predictors of BMD. In women, after accounting for covariates (age, BMI, total fat, android:gynoid ratio), SB (hours/day), SB (% waking hours), LIPA (hours/day), LIPA (% waking hours), MVPA (% waking hours) and number of short SB (i.e., <5 min), total time spent in PA (min) significantly correlated with BMD. In conclusion, the PB predictors of bone health in older persons include: night time sleeping duration, number of short bouts of SB, number and duration of bouts of PA relative to total waking hours. While radar graphs of PB patterns for healthy, osteopenic, osteoporotic individuals highlighted significant differences in PB between them, they were not consistent with the expectations from the Mechanostat Theory: i.e., more loading leads to better bone. Rather, our results suggest that a balance of activities must be maintained across the PB spectrum, where certain PB parameters are especially impactful in each sex, supporting the recently coined multifactorial-based variations in the Mechanostat threshold.

BACKGROUNDThe aim of the study was to provide an isotemporal substitution model to predict how changes in physical behavior may affect the cardiovascular parameters (CVPs) of older adults.METHODSParticipants wore a thigh-mounted accelerometer for 7 days. Phenotype of the carotid, brachial, and popliteal artery was conducted using ultrasound. Isotemporal substitution was used to simulate the degree to which replacing 1 hour of physical behavior with another would affect CVP.RESULTSSubstitution of sedentary behavior with Standing and sporadic moderate- to vigorous-intensity physical activity (MVPA accumulated in bouts <10 min) would reduce resting heart rate [-6.20 beats per minute (-12.1 to -0.22) and -3.72 beats per minute (-7.01 to -0.44), respectively]. Substitution of sedentary behavior with light-intensity physical activity would reduce carotid artery diameter [-0.54 mm (-1.00 to -0.07)]. Substitution of Standing with sporadic MVPA would increase popliteal artery diameter [1.31 mm (0.11 to 2.51)].CONCLUSIONSOur modeling suggests that an accumulation of MVPA bouts that are shorter than the recommended 10-minute minimum may still improve CVP, with lower intensity physical activity also influencing CVP. Our findings are a promising avenue for lifestyle interventions in older adults to reduce the aging effects on CVP for those who cannot engage or sustain sufficient MVPA.

Background The aim was to determine the reliability and validity of IPAQ measured sedentary behaviour (SB) and moderate–vigorous physical activity (MVPA) in older persons whilst examining any sex differences in reliability and validity results. Method 89 participants (73.7 ± 6.3 years, 54% female) completed the IPAQ. Participants were fitted with a thigh mounted triaxial accelerometer (GeneActiv Original) for seven consecutive days and subsequently completed a second IPAQ. Results IPAQ showed weak reliability qualities for Total SB (h·week-1) and 10 minute MVPA (accumulated in bouts ≥ 10 continuous minutes, h·week-1). IPAQ had poor concurrent validity qualities for Total SB, 10 minute MVPA, but not Sporadic MVPA (accumulated in bouts < 10 continuous minutes, h·week-1). IPAQ only categorised participant physical behaviour classification correctly 2% of the time. Sex differences were only present for the correlation slope of IPAQ 10 minute MVPA reliability measures. Conclusion Our data suggests that the IPAQ is not suitable for assessing older adults habitual physical behaviour.

In recent years, sedentary behaviour (SB) has been identified as a health risk, independent of physical activity (PA). With the population becoming increasingly sedentary, detailed analysis of its effects is required. It is proposed that in the elderly, arguably the most sedentary age group, SB might adversely affect musculoskeletal health hence leading to poorer physical functioning, less independence and higher risk of falling. Hence, this thesis aimed to study the associations between SB and muscle-tendon properties in older adults (aged ≥60 years). To do so, a machine learning algorithm was applied onto thigh-mounted accelerometry data. Algorithm performance was acceptable for a wide spectrum of physical activity intensities, and its concurrent validity was good. Then, a cross-sectional study on 105 older adults included a 7-day habitual activity monitoring week, and assessed gastrocnemius medialis (GM) muscle-tendon morphology, architecture, function, fatigue indices, mechanical and material properties, and postural balance. From the accelerometer data, both total amount and patterns of SB were extracted. Analysis of these outcomes ranged from simple comparison of general SB levels to compositional data analysis. Multiple linear regression models showed a few associations linking SB with detrimental outcomes with GM muscle properties (dimension, strength and force). Similarly, isotemporal substitution yielded a limited number of significant potential relative effects of SB behaviour alterations. GM tendon mechanical, material and morphological properties also showed associations. Interestingly, negative associations between SB and postural balance in this group of older adults were also identified. Overall, this thesis presents novel data from detailed analyses on SB and intrinsic muscle-tendon properties in older adults. Regardless of the somewhat limited associations between sleep and PA-independent SB outcomes and GM muscle-tendon properties in older adults, the negative relationship with a task associated with habitual physical independence (i.e. postural balance) warrants further investigation of SB in elderly.

BACKGROUNDPhysical behavior [PB, physical activity (PA), and sedentary behavior (SB)] can adjust cardiovascular mortality risk in older adults. The aim of this study was to predict cardiovascular parameters (CVPs) using 21 parameters of PB.METHODSParticipants [n = 93, 73.8 (6.23) y] wore a thigh-mounted accelerometer for 7 days. Phenotype of the carotid, brachial, and popliteal arteries was conducted using ultrasound.RESULTSSedentary behavior was associated with one of the 19 CVPs. Standing and light-intensity PA was associated with 3 and 1 CVP, respectively. Our prediction model suggested that an hourly increase in light-intensity PA would be negatively associated with popliteal intima-media thickness [0.09 mm (95% confidence interval, 0.15 to 0.03)]. sMVPA [moderate-vigorous PA (MVPA), accumulated in bouts <10 min] was associated with 1 CVP. 10MVPA (MVPA accumulated in bouts ≥10 min) had no associations. W50% had associations with 3 CVP. SB%, alpha, true mean PA bout, daily sum of PA bout time, and total week 10MVPA each were associated with 2 CVP.CONCLUSIONSPatterns of PB are more robust predictors of CVP than PB (hours per day). The prediction that popliteal intima-media thickness would be negatively associated with increased standing and light-intensity PA engagement suggests that older adults could obtain health benefits without MVPA engagement.

Accurate monitoring of sedentary behaviour and physical activity is key to investigate their exact role in healthy ageing. To date, accelerometers using cut-off point models are most preferred for this, however, machine learning seems a highly promising future alternative. Hence, the current study compared between cut-off point and machine learning algorithms, for optimal quantification of sedentary behaviour and physical activity intensities in the elderly. Thus, in a heterogeneous sample of forty participants (aged ≥60 years, 50% female) energy expenditure during laboratory-based activities (ranging from sedentary behaviour through to moderate-to-vigorous physical activity) was estimated by indirect calorimetry, whilst wearing triaxial thigh-mounted accelerometers. Three cut-off point algorithms and a Random Forest machine learning model were developed and cross-validated using the collected data. Detailed analyses were performed to check algorithm robustness, and examine and benchmark both overall and participant-specific balanced accuracies. This revealed that the four models can at least be used to confidently monitor sedentary behaviour and moderate-to-vigorous physical activity. Nevertheless, the machine learning algorithm outperformed the cut-off point models by being robust for all individual's physiological and non-physiological characteristics and showing more performance of an acceptable level over the whole range of physical activity intensities. Therefore, we propose that Random Forest machine learning may be optimal for objective assessment of sedentary behaviour and physical activity in older adults using thigh-mounted triaxial accelerometry.

BACKGROUND:Cervical neck pain is often caused by cervical disk pathology and may cause severe symptoms and disability. Surgeons and patients are increasingly aware of postsurgery-related complications. This stimulated the clinical usage of minimally invasive treatments such as percutaneous nucleoplasty (PCN) and pulsed radio frequency (PRF). However, scientific evidence on both treatments is limited.OBJECTIVE:Our objective was to evaluate the efficacy of PCN compared to PRF in patients with contained cervical disk herniation.METHODS:A prospective randomized clinical trial was conducted including 34 patients with radicular pain due to a single contained cervical disk herniation who were treated with either PCN or PRF. Demographic data were collected, and the Medical Outcomes Study 12-Item Short Form (SF-12) Health Survey, visual analog scale (VAS), and the Neck Disability Index (NDI) were completed 1, 2, and 3 months after treatment. Treatment satisfaction and complications were recorded.RESULTS:In the PCN group (n = 17, mean age 52.4 years, 10 female/7 male), patients were treated at C5 to C6 (8 cases) or C6 to C7 (9 cases). In the PRF group (n = 17, mean age 49.5 years, 8 female/9 male), patients were treated at C3 to C4 (1 case), C5 to C6 (10 cases), or C6 to C7 (6 cases). At 3 months, mean pain VAS improved significantly from baseline in the PCN group (mean improvement: 43.4 points) and in the PRF group (34.0 points). However, improvement in 1 group was not superior compared to the other group (P = 0.48). No serious complications were reported.CONCLUSION:Within 3 months, both PCN and PRF show significant pain improvement in patients with contained cervical disk herniation, but none is superior to the other. Both treatment options appear to be effective and safe in regular clinical practice.

Purpose: Recent studies of metal-on-metal (MoM) total hip arthroplasty (THA) using metal-artefact-reducingsequence software for magnetic resonance Imaging (MARS-MRI) have revealed remarkable soft tissue pathology around the hip, usually referred to as pseudotumours. Case reports describe identical pathology in non-MoM THA, but descriptive overviews of MRI abnormalities in patients with non-MoM prosthesis are scarce.Methods: A clinical study in a cohort of 50 ceramic-on-polyethylene (CoP) THA selected for high risk of periprosthetic pathology including 2 subgroups: (i) 40 patients with a high polyethylene (PE) wear rate (>0.2 mm per year) and 5-12 years follow-up; (ii) 10 patients with a 2 to 5 years follow-up and a documented history of persistent complaints. All patients were clinically evaluated, MARS-MRIs were completed and chrome and cobalt serum samples were taken.Results: 17 scans were normal (34%). Periprosthetic fluid collections were seen as a bursae iliopsoas (n = 12, 24%), in the trochanter bursae (n = 4, 8%) and in the surgical tract (n = 9, 18%). 1 case demonstrated a cyst on MARS-MRI resembling a pseudotumour as seen with MoM THA (2%). Intraosseous acetabular cysts were seen in 12 cases (24%), intraosseous trochanteric cysts in 10 cases (20%).Conclusions: Soft tissue abnormalities after non-MoM THA are common in selected patients and can be clearly visualised with MARS-MRI. Pseudotumours as seen on MARS-MRI do occur in non-MoM hip arthroplasty but with low prevalence.

This literature review focuses on aspects of sedentary behaviour (SB) in elderly. Since it has been identified as a distinct health risk, independent of physical activity, SB is a significant issue. This is particularly true for an ageing population as evidence shows that older adults (aged ≥65 years) are the most sedentary age group (on average 8.5–9.6 h daily sitting time). Accurate SB assessment is important for understanding this habitual behaviour and its impact. However, SB measurement is challenging, regardless of the method used. Although negative associations of SB in elderly have been reported for several health outcomes, evidence is inconclusive, apart from the evidence on the adverse SB effect on the all-cause mortality rate. Generally, strategies have been proposed to counteract SB, of which breaking prolonged sedentary bouts with at least light-intensity physical activity seems to be the most promising. Overall, further research in elderly is required to increase the evidence and to either support or refute the current findings. Moreover, further research will help to develop informed SB guidelines for an optimal strategy to counteract SB and its health effects in older adults.